Bipolar Medication Names & Facts Flashcards
Drugs that may trigger mania
Amphetamines Bromides- Sedative Cocaine Antidepressants Isoniazid- anti TB drug Procarbazine- Chemotherapy Steroids Stimulants
Dysregulation Theory
Not specific to bipolar but mood in general
Failure in some part of a homeostatic mechanism that regulates mood
Chaotic Attractor Theory
Biochemical defect leads to the dysregulation of neurotransmitter synthesis. Symptom presentation varies based on the physiological and environmental conditions at that time
Kindling Theory (Ballinger and Post)
Symptoms result of cumulative effects of subclinical biochemical changes in the limbic system
The progressive buildup causes neurons to become more excitable until symptoms appear
Progressive changes over time explain increased frequency and severity of episodes with aging
Catecholamine Theory
Noradrenergic abnormalities predominate and are measured by concentrations of norepinephrine and its major metabolite (MHPG)
Probably not the primary causative factor
Urinary levels of MHPG are lower in bipolar depressed and higher during mania
Levels also lower in bipolar depression than unipolar depression
In manin, CSF concentration of NE and MHPG are increased
Genetic and Familial Theories
Adoption, twin, and familial studies support that bipolar is heritable
Concordance rates for monozygotic twins 50-60% for bipolar
Chromosome 22 has been implicated in both bipolar disorder and schizophrenia
carbamazepine
(Tegretol)
Anticonvulsant (Note: 2nd generative anticonvulsants have significant side effects- limiting their use, also have birth defects) (& Mood Stabilizer)
Inhibits the release of glutamate (Equator is the extended release form)
Prescribed for acute mania, bipolar depression, bipolar maintenance
Must monitor serum levels (4-10 mcg/ml)
SE: Sedation dizziness, drowsiness, blurred vision, poor coordination, N/V, diarrhea, abdominal pain, decrease white blood cells, red, itching rash or hives, numerous drug reactions
lamotrigine
(Lamictal)
3rd generation anticonvulsant (& Mood stabilizer)
Effective for acute bipolar depression and RC bipolar II, as well as prevention of recurrent bipolar depressive episodes
Now the 1st line of treat for RC bipolar II
Less likely to cause a manic shift compared to other antidepressants
NOT used for acute mania
Rapidly absorbed
No monitoring of serum levels required
Can improve cognitive functioning
Adverse side effects increase with higher doses
SE: dizziness, tremors, somnolence, headache, nausea, rash ***Stevens-Johnsons syndrome risk (life threatening condition affecting the skin in which cell death cases the epidermis to separate from the dermis)– risk increases with concomitant use of divalproex
gabapentin
(Neurontin)
Anticonvulsant
Used to treat partial complex seizures, bipolar (not typically), anxiety, neuropathic pain, substance dependency, behavioral dyscontrol, and chronic headaches
Increases GABA levels but unclear how
pregabalin
(Lyrica)
Anticonvulsant
Derivative of gabapentin (but much more potent than gabapentin, 2-3 times as much)
Treats pains, seizures, fibromyalgia
Not specifically used for bipolar
topiramate
(Topamax)
Anticonvulsant
Used to prevent relapse to detrimental drinking patterns in people with alcoholism (common in patients with bipolar), also used to treat migraine headaches
Questionable effectiveness for bipolar
Weight LOSS as opposed to weight gain so can be used to offset the weight gain associated with other treatments
Excreted unchanged (meaning not metabolized by the liver) and reduced likelihood of drug interactions
Potential to increase plasma levels of other drugs excreted by kidneys, such as lithium
Increased incidence of kidney stones
zonisamide
(Zonegran)
Anticonvulsant
Mixed results in treatment of bipolar
High drop out rate due to side effects (worsening of mood, sedation, lack of effectiveness, more serious SE: decreased WBC, increased liver enzymes, drug interactions
oxcarbazepine
(Trileptal)
Anticonvulsant
Primarily used to treat seizures, but also treats bipolar, migraines, and nerve pain (although not FDA approved to treat these)
Trileptal is primarily exerted through its active metabolite (MHD)
Excreted by the kidneys
May cause the level of sodium in your blood to be dangerously low
Several drug interactions
valproate (aka valproic acid, sodium valproate, divalproex sodium)
(Depakote)
Anticonvulsant (& Mood Stabilizer)
FDA approved to treat epilepsy, bipolar, and migraines
Mostly metabolized in the liver. However, a small percentage absorbed by mitochondria
As with most anticonvulsants, mechanism unknown
Reduces the severity of mania, used to prevent long term recurrence of mania, in some cases has helped to lower depression associated with bipolar
Some SE: liver damage, suicidiality, anemia, pancreatitis, polycystic ovarian syndrome
interacts with anticoagulants, other anticonvulsants, drugs that depress the CNS (e.g., muscle relaxers)
Therapeutic window is small*
lithium
Lithobid
Mood stabilizer
For bipolar, first line= mood stabilizer (addresses mania), depression is addressed later with a different medication
Only 60-70% of those with bipolar disorder can be adequately controlled by lithium alone
Regulates mood, helps to decrease severity and frequency of mania
Lithium less effective in controlling RC mania- need for adjunct or alternative intervention for treatment resistant, noncompliance, or lithium side effects
Decreases risk of suicide
NOT protein bound
Absorption is rapid
No one really understand mechanism of action- but decreases excitatory transmission in neurons by lowering levels of dopamine and glutamate, and increases inhibitory transmissions by increasing levels of GABA and serotonin
1-3 weeks- therapeutic level, therapeutic window is small*
No antidote for lithium except for dialysis
